Music-Centered Music Therapy Interventions with the Viola
Kimiko Suzuki
A Thesis
in
The Department
of
Creative Arts Therapies
Presented in Partial Fulfillment of the Requirements
for the Degree of Master of Arts
Concordia University
Montreal, Quebec, Canada
April 2018
© Kimiko Suzuki 2018
CONCORDIA UNIVERSITY
School of Graduate Studies
This is to certify that the thesis prepared
By: Kimiko Suzuki
Entitled: Developing Music-Centered Music Therapy Interventions with the Viola
and submitted in partial fulfillment of the requirements for the degree of
Master of Arts (Creative Arts Therapies, Music Therapy Option)
complies with the regulations of the University and meets the accepted standards with
respect to originality and quality.
Signed by the final Examining Committee:
______________________________________ Chair
Sandra L. Curtis
______________________________________ Examiner
Guylaine Vaillancourt
______________________________________ Examiner
Kristen Corey
______________________________________ Supervisor
Sandra L. Curtis
Approved by ________________________________________________
Yehudit Silverman, Chair, Department of Creative Arts Therapies
________YEAR ___________________________________
Rebecca Taylor Duclos, Dean, Faculty of Fine Arts
iii
ABSTRACT
This research involved the creation of music therapy interventions making use of the
viola within a music-centered music therapy framework. The researcher elaborates on her
background and experience using the viola as her primary instrument, which contributes
to the design of four separate interventions. The literature review reveals that there are a
number of music therapists who have evaluated the use of their primary instrument in a
self-reflexive manner; these accounts were used to further examine the importance of
using one’s own musicality and create a guideline for the use of viola. The music-
centered music therapy orientation as conceptualized by Kenneth Aigen is summarized
and supports the ideas regarding the aesthetic qualities and how they influence clinical
goals. The interventions developed included using the viola for improvisation, receptive
listening, conducting, and movement to music. Steps were described within each
intervention in order for other music therapists to be able to follow and replicate them as
easily as possible. Considerations to be aware of before implementing each intervention
are discussed, such as assessment and evaluation information for clients, as well as
indications and contraindications that may emerge. While the research served to create
the interventions from a music-centered perspective based on past studies on one’s
primary instrument in music therapy, the interventions were not tested. Future research
that could test these interventions would be beneficial for the growth of knowledge
within this field, particularly by music therapists who can provide a different viewpoint
and perspective.
iv
ACKNOWLEDGEMENTS
I would like to thank all my professors and the faculty at Concordia University for
helping this thesis come to fruition, particularly my advisor Sandi Curtis.
I would also like to express my appreciation for my peers in the program, who have
helped to motivate me and push myself to work hard, while also making the process more
enjoyable.
I could not be where I am today without the family and friends who have supported me
along the way, in addition to my music teachers and colleagues who accompanied me on
my journey to becoming a violist and music therapist.
v
Table of Contents
Chapter 1. Introduction .............................................................................................. 1 Researcher-Student Stance ................................................................................................2 Assumptions ......................................................................................................................3 Purpose Statement ............................................................................................................3 Key Terms ..........................................................................................................................3 Chapter Outline .................................................................................................................3
Chapter 2. Literature Review ...................................................................................... 5 Music-Centered Music Therapy ..........................................................................................5 Prominent Music Therapists and Their Primary Instruments ...............................................6 Use of the Viola in Music Therapy ......................................................................................6 String Instruments .............................................................................................................8 Wind Instruments ..............................................................................................................9 Keyboard and Percussion Instruments .............................................................................. 11 Summary ......................................................................................................................... 12 Research Questions ......................................................................................................... 13
Chapter 3. Methodology .......................................................................................... 14 Intervention Research Design ........................................................................................... 14 Data Collection Procedures .............................................................................................. 15 Data Analysis Procedures ................................................................................................. 15 Delimitations ................................................................................................................... 15
Chapter 4. Results ................................................................................................... 17 Risk Factors, Protective Factors and Promotive Factors ................................................ 17 Practical Considerations ................................................................................................. 17 Physical Characteristics of the Viola ............................................................................... 17 Musical Characteristics of the Viola ............................................................................... 18 Portability and Safety ..................................................................................................... 18 Musical Background ....................................................................................................... 18 The Therapist’s Relationship with the Viola ................................................................... 19 The Client’s Musical Experience .................................................................................... 19 Abilities and Challenges .................................................................................................. 19 Self-Awareness of the Therapist...................................................................................... 19 Transference and Countertransference .......................................................................... 19 Malleable Mediators ....................................................................................................... 20
Aesthetic qualities. ............................................................................................................... 20 Client-therapist relationship. ............................................................................................. 21 Goals. .................................................................................................................................... 21
Action Strategies ............................................................................................................. 22 Population. ........................................................................................................................... 22 Setting. .................................................................................................................................. 22 Duration. .............................................................................................................................. 22
Suggested Interventions .................................................................................................. 22 Improvisation ........................................................................................................................ 22 Receptive listening. .............................................................................................................. 24 Conducting. ........................................................................................................................... 25
vi
Movement to music. ............................................................................................................ 26
Chapter 5. Discussion .............................................................................................. 28 Findings Summarized ..................................................................................................... 28
What the researcher has learned. ...................................................................................... 28 Limitations. .................................................................................................................... 28
Scope of research. ................................................................................................................ 28 Researcher’s stance. ............................................................................................................ 28 Cultural implications. ......................................................................................................... 28 What the researcher would have done differently. .......................................................... 29
Implications for Future Research. .................................................................................. 29 Testing interventions. .......................................................................................................... 29 Gathering multiple viewpoints. .......................................................................................... 29 Implementation on other instruments. .............................................................................. 29 Implications for clinical practice. ...................................................................................... 29
References ............................................................................................................... 31
1
Chapter 1. Introduction
When working with clients, music therapists may make use of their skills to
provide the best clinical guidance possible, but do they lose their sense of personal
musicianship in the process? This may depend on the music therapist’s primary
instrument. In a survey of 249 music therapists, Angela Voyajolu (2009) found that an
orchestral string instrument was the primary instrument of 5.6% of respondents, and
57.1% of those string players had not used their instrument in clinical music therapy
work in the past year. One reason for this could be a gap in current music therapy training
for students who use orchestral instruments (Oldfield, 2015).
Addressing this gap may have significant implications for practice; a recent music
therapy publication entitled, “Flute, Accordion or Clarinet? Using the Characteristics of
Our Instruments in Music Therapy” advocates for therapists’ use of their primary
instruments because of the meaningful relationships they have with them, which could
offer therapeutic benefits (Loombe, Rodgers, Tomlinson, & Oldfield, 2015). In one
chapter, authors Angela Harrison and Oonagh Jones (2015) share case vignettes
involving their use of the viola to achieve clinical goals with clients. In another
publication, Jones (2004) argues that the music created from one’s primary instrument
has a significant impact on the development of trust and connection in the therapeutic
relationship because the therapist’s use of her/his own musical identity is an authentic
sharing and use of self (Jones, 2004).
However, even with this information in mind, there may not be sufficient
resources for music therapists to know how to implement their own musical identity in
practice. Although several publications, including books, articles, and theses, have been
written about how to use such instruments in therapy as voice (Baker & Uhlig, 2011),
piano (Gilboa, Zilberberg, & Lavi, 2011), guitar (Soshensky, 2005), and percussion (Bell,
2016), very little has been written to date in terms of the use of viola or other orchestral
string instruments. What has been written consists of considerations for clinical practice
based on the personal experiences of practitioners, such as resources for improvisation
and musical technique (Lee, Berends, & Pun, 2015; Matsumura-McKee, 2010), or
descriptions of the use by prominent music therapists such as Helen Bonny, Tony
Wigram, and Juliette Alvin of their primary instruments (Odell-Miller, 2011; Stige, 2000;
2
Vaux, 2010). However, none of these publications describe any specific music therapy
interventions that use orchestral string instruments. Nor is there reference to the impact, if
any, of instrumentation in clinical practice? One study found that, while listening to
recorded music resulted in significant changes in anxiety reduction on university music
students, the instrumentation of the piece of music did not affect levels of anxiety
(Matney, 2017). From a music-centered theoretical perspective, the viola can be seen to
provide a unique aesthetic experience in music therapy, which may resonate with
particular clients and thus may have a unique influence on therapeutic processes and
outcomes (Aigen, 2008).
An examination of how the viola is used in various performance settings and a re-
conceptualization of these techniques to be applied within a music-centered model of
music therapy practice could be useful for music therapists who play the viola. It could
provide them guidance in expanding their use of the viola (and other orchestral string
instruments) in their own practice.
Researcher-Student Stance
My inspiration and passion for the practice of music therapy is largely grounded
in my belief that the therapist’s use of musical self is an important part of the music
therapy process, as noted earlier. This belief aligns with elements of a music-centered
approach to music therapy where the therapeutic relationship is conceptualized as a
mutual and equal musical relationship between therapist and client, and the relationship is
“mediated by musical factors” (Aigen, 2005, p. 71). I believe that my philosophical
stance and musical background, in combination with information from the literature, can
be combined to develop unique and creative music therapy interventions that can be
applied to practice and future research.
As well, by drawing from my own practical experiences as a musician who has
focused on viola performance for over 15 years and a music therapy intern who has
worked in pre-professional and advanced internship settings, I may be able to conduct a
study that through its process and/or results, could contain elements of transferability that
other music therapists may use to develop their own interventions with “nontraditional”
3
music therapy instruments (i.e., instruments other than piano, voice, guitar, and
percussion).
Assumptions
I assume that the music therapist’s musical identity and primary instrument are
important tools for achieving clinical goals; that potential clients in the future might be
open to receiving these interventions; and that music therapists might be interested in
incorporating these interventions and/or the concepts underlying the development of
these interventions into their practices.
Purpose Statement
The purpose of this research was to design music therapy interventions that utilize
the viola within a music-centered theoretical framework. This focus on the use of the
viola in a music therapy context arose out of the significant role this instrument played in
my emerging identity as a new music therapist. The intent was also to provide a model to
support other music therapists in considering ways they could use their own primary
instrument in clinical work.
Key Terms
Music-Centered Music Therapy is defined as an approach to music therapy
practice in which music plays a necessary role in the therapeutic experience, rather than
one that is auxiliary to non-musical concepts (Aigen, 2014). Intervention is defined as the
“explicit practice [of] principles, goals, and activities” (Fraser & Galinsky, 2010, p. 459).
Music Therapy Interventions are defined as intentional musical experiences that elicit
responses from the client in order to achieve therapeutic goals (Aigen, 2014).
Chapter Outline
Chapter 1 identifies the purpose of this research and summarizes the intent of the
research, along with identifying key terms, the researcher’s stance, and assumptions that
are inherent in the research. Chapter 2 examines the relevant literature used to provide the
data for integration into the research process, and establishes the research questions based
4
on the literature review. Chapter 3 describes the intervention design methodology used to
answer the research question. Chapter 4 details the results, including the development of
the interventions and steps for their potential implementation. Chapter 5 discusses the
research findings, limitations, and potential implications for future research and practice.
5
Chapter 2. Literature Review
This literature review looks at music therapy literature related to the use of the
therapist’s primary instrument in music therapy practice, with a particular focus on the
viola. Main areas include an overview of the theoretical foundation used for this research,
prominent music therapists and their primary instruments, and the use of the viola as well
as other string, wind, keyboard, and percussion instruments in music therapy.
Music-Centered Music Therapy
To better understand why it is important for music therapists to use their primary
instruments, this research uses the framework of music-centered music therapy, which
puts the therapist’s musicianship front and centre. The idea of music as the main
component in the therapeutic process, which can be seen in opposition to a primary focus
on clinical goals, is seen across time and across many different approaches, including
such early models as Nordoff-Robbins Creative music therapy and The Bonny Method
Guided Imagery and Music (GIM); this is further elaborated on within Bruscia’s concept
of music as therapy (Aigen, 2005).
However, Kenneth Aigen, with his 2005 book Music-Centered Music Therapy,
became the champion for a new model where music therapists consider the music used in
interventions with even greater detail, and where the music is far more than simply
complementary to other therapeutic techniques (Aigen, 2005). A music therapist working
within this standpoint may allow the musical process to speak for itself, rather than
elaborating on it with verbal discussion; however, this does not mean that the client’s
personal or sociocultural context should not also be taken into consideration (Aigen,
2005). In addition, what makes this framework particularly unique is its stance on the
music therapist’s use of musical self, acknowledging, “… Some music therapists are
musicians who work in therapeutic contexts to bring the inherent benefits of musical and
musically-based experiences, rather than therapists who use music as a tool to achieve
goals that are not specific or unique to music” (Aigen, 2005, pp. 107-108). With this in
mind, the literature can be reviewed with an eye to how each instrument’s inherent
benefits contribute to the client’s journey through music therapy.
6
Prominent Music Therapists and Their Primary Instruments
While music therapy training in general tends to focus more on instruments such
as guitar, piano, and percussion, there are prominent practitioners who entered the field of
music therapy with a different primary instrument. It is known that, before contributing to
music therapy work and research at Anglia Ruskin University, Tony Wigram (1953-
2011) played piano and viola skillfully, even acting as a member in the Apollo
Symphony Orchestra (Odell-Miller, 2011).
Another noteworthy music therapist is Helen Bonny (1921-2010), who attended
Oberlin Conservatory majoring in violin performance before developing her pivotal GIM;
she remained a performing musician throughout her career and life (Vaux, 2010). Juliette
Alvin’s primary instrument was the cello. She notably did have many other instruments at
her disposal, such as the piano, guitar, and flute, and chose which was most appropriate
in the moment (Stige, 2000). More recently, Amelia Oldfield has been known for her use
of the clarinet in sessions with children to achieve clinical goals, such as improvement of
communication skills (Oldfield, 2011).
While these music therapists do serve as models for what is possible for music
therapists with non-traditional primary instruments, they have not written specifically
about their personal experiences with these instruments. Making this information
available to others may help them benefit from guidance to know how their practice
could be adjusted accordingly. The following section explores/discusses examples of
research that has done so.
Use of the Viola in Music Therapy
Research concerning the use of the therapist’s primary instrument in music
therapy has been limited to a degree, with a few notable publications. A recent
collaboration between practitioners within the United Kingdom (UK) showcases a
collection of personal accounts and case vignettes that detail how each instrument can be
used for unique purposes (Loombe, Rodgers, Tomlinson, & Oldfield, 2015). Another
recent publication includes chapters by Canadian music therapists addressing the use of
their primary instrument in practice, including improvisational resources and repertoire
7
for practicing (Lee, Berends, & Pun, 2015). Others have written about techniques and
resources for using the voice as a primary instrument in music therapy practice (Baker &
Uhlig, 2011), and how the human voice can convey emotion and behaviour when
manipulated with proper awareness and training (Uhlig, 2009).
While all these accounts describe positive interactions when using a variety of
instruments, one study of 249 music therapists in the United States (U.S.) shows that the
majority of those therapists who play orchestral instruments such as strings, woodwinds,
and brass had not used their instrument in their practice in the past year (Voyajolu, 2009).
This might indicate that professionals need more resources to allow them to use their
primary instruments more effectively. By contrast, an online survey of 107 music
therapists working in Israel was recently conducted by Wiess, Dassa, & Gilboa (2017).
They found that 4.2% of music therapists who had been working for more than 8 years
considered a string instrument their secondary instrument compared to 5.2% of music
therapists who had been working for less than 8 years and considered a string instrument
their primary instrument (Wiess, Dassa, & Gilboa, 2017). A possible interpretation of this
data is that within the context of Israel, newer professionals might be more open to using
instruments other than the conventional piano, guitar, and voice as their primary
instrument.
Bonnie Brittain (2013), in an analysis of music recordings from her own music
therapy sessions playing the viola, observes how different playing techniques and musical
styles might evoke a wide range of feelings. She also details in a further publication how
to use and practice different styles on the viola, such as using Baroque and Folk music
(Brittain, 2015). Additionally, Oonagh Jones (2004) addresses this topic in her master’s
dissertation, arguing that the music created from one’s primary instrument has a
significant impact on the development of trust and connection in the therapeutic
relationship. Jones and her colleague, Angela Harrison, also describe how the viola
evokes qualities of the human voice, like the violin, but describe its sound as more
melancholic; they note that its role as an accompanying instrument in orchestral music
makes it suitable for weaving in and out of melodies to provide depth and support
(Harrison & Jones, 2015). While these findings provide intriguing insight into how the
8
viola may be used, there appears to be no research that expands or builds on these
findings.
When focusing on my own primary instrument, I found only a few music
therapists who have written on their use of the viola in music therapy. In light of this
paucity of viola-specific literature and with the intention of getting a larger picture of
music therapists’ understanding of the importance of their instruments, what follows is a
broader review of the literature which addresses the use of other string, wind, keyboard,
and percussion instruments.
String Instruments
While there has been little research specifically focused on the use of string
instruments in music therapy, there have been more music therapists describing their
personal experiences with these instruments in recent years. One paper details the process
of analyzing listeners’ interpretation of techniques played on the violin, which informed
the researcher’s understanding of the listeners’ experiences and influenced her use of her
own instrument (Matsumura-McKee, 2010a). The same researcher also pursues a process
of critical self-reflection concerning the violin and its representation of power and
privilege; she encourages other music therapists to utilize this same process of critical
self-reflection through a sociocultural lens (Matsumura-McKee, 2010b). Matsumura-
McKee further details the use of articulation, textural changes, and accompanying figures
with the violin in clinical work (Matsumura-McKee, 2015). Other music therapists who
have written about the use of the violin emphasize the instrument’s potential as a tool for
encouraging movement, eliciting vocalizations, and representing vulnerability (Bell,
Haire, Montague, & Warnes, 2015). These researchers make a strong case that the violin
is an instrument with unique features that can have significant implications when used
clinically.
Building on these ideas, similar points are seen with lower strings. Sarah Kroeker
(2015) notes that the cello is an ideal instrument for utilizing grounding structure through
basso continuo or ostinato (Kroeker, 2015). Elaborating on other uses for the cello in
music therapy, Hughes, Tyhurst, Warner, and Watson (2015) identify the wide range and
9
quality of sounds on the cello, but cite challenges related to portability when considering
whether to use it in sessions (Hughes, Tyhurst, Warner, & Watson, 2015).
As with the grounding qualities of the cello, the double bass in music therapy can
provide a strong pulse when used in Jazz or Latin walking basslines and grooves (Wan,
2015). Speaking from their experiences, Joseph Piccinnini, Paolo Pizziolo, and John
Preston (2015) note that clients and therapists can be drawn to the vibrations and low
notes produced by the double bass and bass guitar. Their perception as “cool” instruments
can also be motivating. Coming from another string family, the harp is a clearly soothing
and relaxing instrument for clients; it may also be overpowering due to its size and range
(Gottlieb, Lockett, & Mentzer, 2015). Contrasting the grounding grooves of the cello and
bass with the more vocal qualities of the violin, as well as the calming qualities of the
harp, it is apparent that corresponding interventions could be different with these
instruments and thus used to achieve different goals.
Having explored those string instruments that may be more nonconventional, it is
important next to discuss the use of some more commonly-used instruments in music
therapy. Guitar seems to be a popular choice for music therapists to use because of the
client’s preference for this instrument, as seen particularly with adults (Krout, 2007). In a
case study, one researcher describes use the guitar’s unique characteristics in Nordoff-
Robbins music therapy, an approach known for being primarily piano-based (Soshensky,
2005). This provides an example that music therapists might use to adapt approaches to
better suit the needs of their primary instrument. Others who use the guitar in their work
credit the acoustic guitar’s resiliency, portability, versatility, and flexibility in terms of
different tunings as qualities that make it an ideal accompanying instrument for singing;
they also highlight the calming effect of the classical guitar (Lyons, Poole, Long, Street,
& Stylianou, 2015). While these string instruments may have some similar
characteristics, such as ease of accompanying clients, they clearly have their own unique
uses, as seen in the literature.
Wind Instruments
While there is even less research on the use of wind instruments in music therapy
than with string instruments, what is available seems to demonstrate a wide range of
10
possibilities. Schenstead (2009) makes use of a heuristic arts-based approach to identify
personal experiences of improvisation on the flute. In identifying specific qualities of the
flute for use in music therapy, its extension of the voice and use of breath is emphasized
by other flutists (Anderson, Austin, Corke, Fearn, Mitchell, & Tomlinson, 2015).
However, some practical considerations should be noted such as the importance and
difficulty of maintaining evenness of tone when breathing and switching registers
(Lepnik, 2015). Such factors should be considered by therapists in choosing to use their
primary instrument.
In a detailed case study analysis, Berends (2014) concludes that the use of oboe
and English horn in sessions can be powerful, but practitioners must always use a critical
listening ear. While Berends observes that the oboe has a much focused sound that can
bring considerable energy to sessions, the volume level and quality of the reed are
important to keep in mind (Berends, 2015). However, others note that when used
appropriately, the oboe can easily express and reflect feelings of sorrow or anxiety
(Bettany, Dickinson, & Knoll, 2015).
Although in a similar family to the oboe, the clarinet is more able to evoke
feelings related to reminiscence, relaxation, and safety (Lee & Cheung, 2015).
Researchers also reference the clarinet’s playfulness, as seen in its ability to elicit
responses through such special effects as glissandi, note bends, and squeaks (Dunn,
Oldfield, Piears-Banton, & Salkeld, 2015).
Another reed instrument that can produce breathy sounds and a range of tone
colours, the bassoon can enhance the therapeutic relationship through its warmth and
richness (Birnstingl, Margetts, Burley, & Watts, 2015). While these woodwind
instruments may evoke memories or feelings within Western art music, they may also be
used with a variety of musical styles. Those who use the saxophone also reference
elements of “coolness” when using Jazz improvisation techniques and versatility of
sounds, but go further in describing its sensory nature due to the bell and keys, and
elaborating on issues related to reeds and hygiene (Annesley, Crociani, Davidson, & Vaz,
2015). Hence, the structural similarities of woodwind instruments are juxtaposed against
their practical and timbral differences.
11
Within the family of brass instruments, the trumpet and flugelhorn also have
vocal qualities, versatility, and visual appeal, but further represent self-assurance through
a powerful sound and stance when played (Derrington, Gilroy, Hason, & Tomaino,
2015). With its loud presence and chromatic slide, the trombone can bring humour to
sessions like the clarinet, but can also bring warmth to clients when played melodically
and legato (Allen, 2015). Other lower brass instruments, such as the euphonium, can
provide stimulation through vibrations, and also reflect feelings of anger through very
full and loud sounds (Aasgaard, Murray, & Mottram, 2015). While the reviewed
literature identifies challenges for the use of wind instruments in music therapy,
especially related to portability or hygiene, it is clear that the novelty of each one and the
intentional use of breath could be quite meaningful for clients.
Keyboard and Percussion Instruments
While piano and a variety of percussion instruments are widely used in music
therapy today, it is important to note why we do so and how we can use them to their best
advantage. One study took a phenomenological perspective to examine music therapists’
perceptions of the “musical personality” (Gilboa, Zilberberg, & Lavi, 2011, p. 138) of the
piano, taking their personal and clinical experiences into account, and found that there
were mixed feelings, including strong positive or negative reactions as well as ambivalent
reactions (Gilboa, Zilberberg, & Lavi, 2011). This could indicate that one’s relationship
with a musical instrument may be indicative of or dependent on previous experiences, an
important consideration for music therapists.
In terms of the accordion family, the bellows can mimic breath and produce
strong vibrations similar to wind instruments, but the mechanisms can also be quite
percussive while providing dynamic range and full harmonic accompaniment
(Greenhalgh, Loombe, Powell, Santilly, & Ward-Bergeman, 2015). Even having played
an instrument for an extended period of time, one’s relationship may change with it as
their musical identity evolves. A music therapist who also is an orchestral marimba
player consulted the literature to determine possible clinical implications and how to
draw from experiences as a performer, and found that the marimba’s distinctive resonant
qualities can be very effective in a therapeutic context (Sun, 2012). In other writings, Sun
12
also described her use of keyboard percussion like the marimba and xylophone to
produce a large variety of sounds, depending on the register and mallets (Sun, 2015).
Although these instruments may have similarities in technique and theory, their aesthetic
qualities are widely varied, opening up a number of possibilities for interventions.
When using percussion instruments, it is important to also acknowledge
instruments outside of the Western music framework. Loth (2006) notes that Gamelan
music can be significant for those involved in a number of ways, such as communicating
within a group, learning to play together without a conductor, and understanding the role
of each instrument. Sumrongthong and Aksaranukraw (2004) adapted a Japanese
Akaboshi method of music therapy that targets hand moving, breathing, and rhythmic
skills, instead using Thai musical instruments to address rehabilitation, which proved to
be difficult due to their size and weight. It appears that when using keyboard or
percussion instruments, physical limitations of the instruments used are especially
important to keep in mind when working with clients.
Summary
As the literature review highlights, musical instruments that are used in music
therapy should be critically considered based on such factors as their portability,
versatility, range, tone colours, and ability to accompany clients. Similarities to the
human voice, use of breath, and sensory elements such as vibrations also seem to be
important. Most importantly, much of the research reviewed discussed the impact of
music therapists using their primary instrument and how it enabled better musical
mastery, use of self, and ease of connection with clients, encouraging others to do the
same when appropriate (Berends, 2014; Brittain, 2013; Jones, 2004; Lee et al., 2015;
Loombe et al., 2015; Schenstead, 2009; Soshensky, 2005; Sun, 2012; Voyajolu, 2009).
Since music therapists often enter the profession as a result of a strong belief in
the power of music as a motivator, it seems that they should heed their own advice and
allow themselves to bring their unique musicianship to sessions and use it as a tool for
clinical work. In addition, when using instruments with which they are not most
comfortable, it may be beneficial to have music therapy literature available to consult in
order to determine how each can best be used. This way, they can provide the best
13
experiences possible for their clients. Furthermore, the implementation of in-depth
research regarding ways that interventions can be developed related to orchestral and
non-traditional primary instruments may help professionals to deepen their practice.
In relation to this research, by looking at how other music therapists have used
their primary instrument most effectively, I can find parallels to using my own primary
instrument and apply them to developing music therapy interventions using the viola.
Because the case is made for using one’s own musicality and applying the aesthetic
qualities of one’s primary instrument to clinical goals, particularly within a music-
centered music therapy framework, I can take my own unique experiences with the viola
and use them to expand on past research to create a specific set of guidelines that other
music therapists can follow.
Research Questions
In light of the findings of the literature review, the following questions were
established:
Primary research question. What music therapy interventions using the viola
can be developed for use within a music-centered theoretical approach to music therapy?
Subsidiary research question. What population(s) might be appropriate for use
of these viola-based music therapy interventions?
14
Chapter 3. Methodology
Intervention Research Design
This study used a modified version of intervention design research (Fraser &
Galinsky, 2010). Intervention research is the study and implementation of strategies to
change practice (Fraser & Galinsky, 2010). The Fraser and Galinsky 5-step model of
intervention research involves: 1) developing problem and program theories; 2) designing
program materials and measures; 3) refining program components through testing; 4)
testing the effectiveness in practice; and 5) disseminating program findings and materials
(Fraser & Galinsky, 2010, p. 459). These steps allow for continuous refinement of a
treatment manual that is reliable (Fraser & Galinsky). This design was deemed to be an
appropriate choice for this study because it provides an established and tested framework
to create thoughtfully-designed interventions that build upon existing research about
music-centered use of instruments. There are examples in the research literature of music
therapists who have used this design for similar means, in order to create practical
resources that future music therapists could utilize or adapt to address clinical needs
(Adout, 2016; Barbieri, 2015; Goldscheid, 2016). Similar to these previous studies, this
current research used only the first two steps of this intervention model. The
identification of problems and development of a program theory was accomplished
through examination and analysis of related literature. This involved the setting,
population, and the function of the viola in the music therapy environment. Following
this step, interventions were defined in terms of criteria, goals, protective factors, and
risks. Sufficient information about how to implement interventions was detailed so that
other professionals in the field would be able to pilot test them should they so choose.
However, testing in practice settings was not included in this research given the
limitations in scope and time of a master’s thesis. Materials used included relevant
literature and the researcher’s own experiences of using her viola in performance and
clinical contexts. Because of the methodology chosen, there were no participants in this
study. However, the researcher did refer to and draw from her own clinical knowledge
and experience.
15
Data Collection Procedures
Relevant sources of data were gathered using online databases through the
Concordia University Library system. Databases include Google Scholar, Discovery
Search, EBSCO, Colombo Inter-Library Loans, and Spectrum Research Repository.
Literature used included articles from peer-reviewed journals, published books, theses,
and dissertations. Literature was found by searching key terms, including “music
therapy”, “viola”, “orchestral instruments”, and “primary instrument”. Once relevant
literature was identified using these key terms, other related literature was found by
looking through the bibliographies, reference lists, and other works by the same authors.
Data was delimited to literature only in English, and from January 2000 to December
2016. Ideas about my own performance and clinical experiences of using the viola were
also documented throughout the research process in journals and memos.
Data Analysis Procedures
Once the data was collected, relevant information from the literature was
identified in relation to the primary and subsidiary research questions. Aspects of Fraser
and Galinsky’s (2010) intervention methodology were used to develop interventions
using the viola in a music-centered music therapy context, and then identify the problem
and needs these interventions might address. Problems that contribute to the development
of program theories were categorized into themes through open and axial coding
(Neuman, 2006). The program measures were then developed based on these themes. The
structure and processes of the interventions were specified based on what was found in
the literature and using the researcher’s reflections on her clinical and musical
experiences.
Possible ethical issues that may arise in this type of research methodology could
be related to the researcher’s bias that could influence the results, and investment in
overextending the potential benefits of the use of the viola in music therapy. These issues
were addressed through ongoing self-reflection and feedback from the academic
supervisor.
Delimitations
16
In light of time and scope constraints inherent in a master’s thesis, a number of
delimitations were set. Only the first two steps of Fraser and Galinsky’s (2010)
intervention design research method were used, a limited number of interventions were
developed (4), and sources of data were delimited to relevant literature in English from
2000 to 2016. The design was not delimited to a particular client population, in order to
allow ideas about how the interventions were used to emerge through the research
process. However, once the literature was reviewed, the program detailed what
population, age, and context were best suited for the chosen interventions.
17
Chapter 4. Results
When constructing these music therapy interventions, there were a number of
components at play that needed to be considered to ensure the greatest chance of success
and efficacy. The following chapter will describe the process of this intervention creation
and the rationale behind their conception.
Risk Factors, Protective Factors and Promotive Factors
Within the intervention design framework outlined by Fraser & Galinsky (2010),
risk, protective, and promotive factors related to a problem must be recognized before
introducing a change strategy (Fraser & Galinsky, 2010, pg. 460). This section will
discuss the prerequisites for developing and realizing these interventions, in addition to
providing context for the music therapist who may want to implement them.
Practical Considerations
The first category of these factors to explore is the feasibility of using the viola itself in
practice. This includes the physical and musical features of the instrument that may
influence its usage, in addition to convenience and safety.
Physical Characteristics of the Viola
One of the first aspects of the viola that is important to consider is its material
construction in comparison with other instruments. The viola has a larger body, lower
range, and thicker strings than the violin, in addition to a heavier bow to produce sound,
all of which can make it more difficult to maneuver (Boyden & Woodward, 2017).
However, violas can be made within a wide range of sizes and shapes, and they can even
be custom-made to fit the owner’s needs (Boyden & Woodward, 2017). Most are
constructed with a wooden body and steel strings, and bows typically use synthetic horse
hair, although more modern violas can be made with a variety of materials such as carbon
fibre and can produce sound electronically rather than acoustically (Boyden &
Woodward, 2017). Music therapists may need to keep in mind additional equipment to
complement the viola in a clinical environment or for personal convenience, such as chin
rests, shoulder rests, rosin for the bow hair, and pickup devices or speakers for
amplification.
18
Musical Characteristics of the Viola
Aside from the physiology that makes up the viola, its musical qualities are another
important consideration to keep in mind. The viola is often described as having “darker,
warmer, richer tone qualities” than the violin (Boyden & Woodward, 2017). The range of
pitch is also more similar to that of the alto voice (Boyden & Woodward, 2017). These
timbral qualities of the viola can be considered more palatable than the violin’s, which
some may consider to be shrill or piercing. Because the viola’s sound production is
controlled by using a bow to vibrate the strings, like all bowed string instruments, it can
sustain sound for virtually unlimited periods of time compared to wind, keyboard,
percussion, and plucked string instruments. The viola’s sound may also be altered with a
mute in order to be more suitable for quieter environments (Shoemark, 2009). However,
because there are no frets on the fingerboard, intonation can be more difficult than with
fretted string instruments (Stowell, 2001, p. 177). While there are almost endless factors
to consider when it comes to the sound of the viola, these are some of the most pertinent
and fundamental for the development of interventions.
Portability and Safety
Perhaps some of the first thoughts a music therapist may have before choosing which
instruments to use in practice involve transportation and sharing between clients. Violas
are best transported in sturdy protective cases equipped with a humidifier, in order to
shield the instrument from environmental dangers to sound quality (Chapman, 2006). In
terms of the therapist’s continued and prolonged use of the viola, therapists should be
aware of orofacial disorders and trauma that can occur due to playing for extended
periods of time, exploring treatment options if any such issues arise (Yeo, Pham, Baker,
& Porter, 2002). If allowing clients to use the viola, music therapists should clean parts of
the instrument that come into direct contact with skin before and after use to avoid
transmission of bacteria and other microbes.
Musical Background
Knowing now the unique features that the instrument brings to music therapy, we can
delve into the effects its music may have on both the therapist and client.
19
The Therapist’s Relationship with the Viola
Within a music-centered framework, we can ascertain that the close relationship a music
therapist may have with the viola and its aesthetic qualities could enhance their practice
and experiences with a client (Aigen, 2005, pg. 100). However, as with any instrument
used within music therapy practice, the reason for its use should be intentional and
measures should be taken to ensure that the music therapist does not have personal bias
that influences their ability to think about the client’s best interests.
The Client’s Musical Experience
In the context of the music-centered music therapy setting, the client’s musical process is
central to their therapeutic growth and development, and their involvement is equally
important (Aigen, 2005, pg. 94). With this in mind, the client’s responses to the viola are
crucial to assess and consider in terms of clinical goals. Although the viola may be
particularly significant for the music therapist, it is important to acknowledge that the
client may come from an entirely different background than that of the therapist, and
therefore may have a very different relationship with the viola or other kinds of music.
Abilities and Challenges
With practical and musical factors now in mind, this section will discuss some
considerations regarding what the therapist can hope to realistically achieve with these
interventions.
Self-Awareness of the Therapist
As addressed above, the music therapist should only carry out interventions using the
viola if they can adequately justify that they are suited for their client’s particular goals
and needs. This may be furthered by clinical supervision, process notes, and continuing
education.
Transference and Countertransference
While the music in a clinical setting may have intrinsic therapeutic value, there are also
transpersonal elements to consider that influence how the therapist and client may
connect with each other (Aigen, 2005). The added element of having a close personal
relationship with the viola could give the music therapist more complex situations
surrounding transference and countertransference, but could also potentially provide a
useful tool for processing these issues.
20
Malleable Mediators
In order to conceive a suitable program theory, components of the intervention that can
be manipulated by the music therapist based on risk factors presented in clinical work
must be identified to work towards positive change (Fraser & Galinsky, 2010).
Aesthetic qualities.
Bowed strokes (legato, staccato, marcato).
The use of bows with string instruments traces back to the 10th century in the Byzantine
empire, and this usage has since evolved along with a variety of musical techniques
(Bachmann et al., 2017). One way to play a bowed stroke is legato, which is defined by
connected or slurred notes and often depicts a more “singing” quality (Chew, 2017).
Opposite to a legato bow stroke is staccato, where notes are played sharply with
emphasis on each note, hence the English translation meaning “detached” (Chew &
Brown, 2017). Similar to staccato but more common in Romantic and Contemporary
music, a marcato bow stroke indicates “stressed” or “accented” notes in a manner that
highlights a particular melody or subject more strongly (Fuller-Maitland & Fallows,
2017).
Pizzicato.
Although the use of bowed strokes is the most common method of producing sound from
a viola, pizzicato can be an effective tool for creating a particular atmosphere, such as
when desiring to imitate a guitar-like sound or imagery such as a “cannon shot”
(Monosoff, 2017).
Extended technique.
Using the viola in ways unconventional to its Western Classical music origins to create a
wider array of sounds has been documented since the early 20th century (Strange &
Strange, 2001). Some popular ways to do this are to use the bow on different contact
points of the strings, make percussive sounds on the body of the instrument, create
harmonic overtones, and to change the tuning (Strange & Strange, 2001).
21
Client-therapist relationship.
If the music therapist uses the viola intentionally in practice, the instrument choice could
contribute to or influence the nature of their relationship to the client (Harrison & Jones,
2015).
Developing therapeutic rapport.
By introducing an instrument of personal significance to the music therapist, and one
which they feel most comfortable with expressing themselves musically, the client may
allow themselves to explore a wider range of emotions within a musical context (Bettany,
Dickinson, & Knoll, 2015).
Goals.
The use of one’s primary instrument in clinical work may contribute to music therapy
goals in a wide range of domains (Piccinnini, Pizziolo, & Preston, 2015). This research
will focus on a select few domains that may have particular pertinence when related to
interventions that utilize the viola.
Communication.
Using the viola as a supporting instrument to the client’s music and allowing them to
explore the viola’s sounds could provide a method to encourage communication within a
safe and comfortable framework (Greenhalgh, Loombe, Powell, Santilly, & Ward-
Bergeman, 2015). In addition, mirroring the client’s vocalizations, sounds, or movements
and incorporating them into the music may allow them to grow their levels of
communication over time (Gottlieb, Lockett, & Mentzer, 2015).
Creative expression.
Due to the versatility and flexibility the music therapist may have with the viola,
demonstrating these skills could open the client’s eyes to the creative possibilities in
making music (Derrington, Gilroy, Hason, & Tomaino, 2015). The viola can also be used
to create non-verbal dialogue, in which the client can more creatively express themselves
in ways they may have felt limited to do previously (Dunn, Oldfield, Piears-Banton, &
Salkeld, 2015).
Emotional exploration.
The viola may lend itself to being an emotional extension of the music therapist, and so
the music used with the viola in sessions may convey a wider range of emotions to the
22
client that they could respond strongly to (Anderson, Austin, Corke, Fearn, Mitchell, &
Tomlinson, 2015). However, because the viola’s sound is often described as melancholic,
the music therapist should be aware of the intense effect it may have (Harrison & Jones,
2015).
Action Strategies
The following section will outline details on how to use these interventions.
Population.
Research on the use of the viola in music therapy has been conducted by Harrison &
Jones (2015) with such clients as adults with visual and hearing impairments, as well as
children and adolescents diagnosed with Autism Spectrum Disorder (ASD). Brittain
(2013) explored her relationship with a client base of non-verbal adults with special
needs while conducting research on her use of the viola. While these interventions may
be used for a variety of populations according to the goals previously addressed, the
researcher is most experienced with using similar interventions with adults in palliative
care, as well as older adults.
Setting.
Research on the use of the viola in music therapy has been done in such settings as a
psychiatric hospital (Harrison & Jones, 2015) and a private music therapy studio
(Brittain, 2013). While these interventions may be used for a variety of settings according
to the goals previously addressed, the researcher is most experienced with using similar
interventions in hospice, long-term care, and nursing home settings.
Duration.
While collecting data on her own relationship with the viola, Brittain (2013) spent seven
research sessions with each participant in order to adequately study musical responses
within a clinical relationship. However, these interventions may be used until the goals
previously addressed have been sufficiently met within a clinical context at the discretion
of the therapist.
Suggested Interventions
Improvisation
23
Assessment and evaluation.
Before using this improvisation, the music therapist should establish a comfortable
therapeutic space for the client and understand what they would like to achieve within the
setting. Risk, protective, and promotive factors should be considered using any
background information and context available regarding the client, as well as thinking
about the therapist’s reasoning for including the viola.
Steps for implementation.
1. The music therapist should discuss with the client the rules and expectations for
the improvisation, and establish the musical framework for the client’s
expression.
2. The music therapist and client should together decide whether the viola will
accompany the client’s instrument playing or vocalizations, and choose a relevant
theme or idea, unless deciding to allow one to emerge through the process.
3. The viola should first play a supporting role to the client’s musical choices by
mirroring and validating their sounds, but the music therapist may elaborate on
them as the music progresses naturally.
4. The improvisation may have a pre-determined ending depending on the amount of
time available, or the music therapist and client may allow the music to continue
as long as necessary.
5. Once the improvisation comes to an end, the music therapist and client may
discuss feelings and thoughts surrounding the music created.
Indications and contraindications.
Indications may include the need for furthering the client’s creative and emotional self-
expression, as understood through the assessment process. Contraindications may include
any mental health concerns surrounding lack of structure or “getting lost” in a moment. If
verbal processing is not possible with the client, the music therapist may adjust this
intervention to communicate instead using visual, auditory, or tactile cues. Any clinical
observations during the intervention in early sessions may lead the therapist to change
aspects of the activity to encourage further engagement and deepening of progress
towards goals in later sessions.
24
Receptive listening.
Assessment and evaluation.
Before using this improvisation, the music therapist should establish a comfortable
therapeutic space for the client and understand what they would like to achieve within the
setting. Risk, protective, and promotive factors should be considered using any
background information and context available regarding the client, as well as thinking
about the therapist’s reasoning for including the viola.
Steps for implementation.
1. Before approaching the client with this intervention, the music therapist should
establish a collection of viola repertoire that includes a diversity of music to
represent different emotional states, energies, and cultures. This repertoire will
naturally grow as the therapist uses this type of intervention more often and
adjusts their selection to a wider base of clients.
2. The music therapist should discuss with the client the rules and expectations for
the receptive listening experience, which could include evoking imagery or
pinpointing an idea. The music therapist may initiate conversation about the
client’s preferred music.
3. After allowing the client to choose from a selection of pre-composed works, the
music therapist will then play a piece of music appropriate for addressing the
client’s goals.
4. While playing, the music therapist should observe how the client is responding to
the music based on their body language and emotional affect, and may need to
adjust their musicality appropriately. This could include the dynamics, phrasing,
or length of the piece.
5. Once the receptive listening experience comes to an end, the music therapist and
client may discuss feelings and thoughts surrounding the music. If verbal
communication is not possible, the music therapist may also allow time for the
client to express their thoughts and feelings afterwards through drawing.
Indications and contraindications.
Indications may include the need for furthering the client’s communication and emotional
self-expression, as understood through the assessment process. Contraindications may
25
include challenges around the client’s ability to keep attention for an extended period of
time. If verbal processing is not possible with the client, the music therapist may adjust
this intervention to communicate instead using visual, auditory, or tactile cues. Any
clinical observations during the intervention in early sessions may lead the therapist to
change aspects of the activity to encourage further engagement and deepening of progress
towards goals in later sessions.
Conducting.
Assessment and evaluation.
Before using this improvisation, the music therapist should establish a comfortable
therapeutic space for the client and understand what they would like to achieve within the
setting. Risk, protective, and promotive factors should be considered using any
background information and context available regarding the client, as well as thinking
about the therapist’s reasoning for including the viola. Earlier sessions may include
introducing the viola and Classical music, in order to discover the client’s relationship
with or feelings towards them.
Steps for implementation.
1. The music therapist will introduce the concept of conducting and explain its
purpose within a musical context, initiating a conversation with the client if
possible to gain a greater understanding of their knowledge.
2. The music therapist and client may together choose a pre-composed piece to
conduct, or it could also be a spontaneous creation.
3. The music therapist will ask the client to conduct the viola music, with the
purpose of influencing choices such as tempo, dynamics, and phrasing. The
therapist will change their performance of the piece based on the client’s
conducting.
4. The exercise may be repeated multiple times in order for the client to feel
comfortable and confident in their execution of the conducting, and the music
therapist may provide feedback if needed.
5. Once the conducting experience comes to an end, the music therapist and client
may discuss feelings and thoughts surrounding the music created.
26
Indications and contraindications.
Indications may include the need for furthering the client’s creative self-expression and to
give them more power within the therapeutic relationship. Contraindications may include
concerns around the client’s preoccupation with controlling their external environment. If
verbal processing is not possible with the client, the music therapist may adjust this
intervention to communicate instead using visual, auditory, or tactile cues. Any clinical
observations during the intervention in early sessions may lead the therapist to change
aspects of the activity to encourage further engagement and deepening of progress
towards goals in later sessions.
Movement to music.
Assessment and evaluation.
Before using this improvisation, the music therapist should establish a comfortable
therapeutic space for the client and understand what they would like to achieve within the
setting. Risk, protective, and promotive factors should be considered using any
background information and context available regarding the client, as well as thinking
about the therapist’s reasoning for including the viola. The music therapist should assess
the motor capabilities of the client and adapt the activity as needed.
Steps for implementation.
1. The music therapist and client will choose a genre or style of music to move to
and choose a suitable ostinato within this musical framework to be played on the
viola. The music therapist will demonstrate possible movements for the client to
follow that are appropriate to the client’s range of motion. However, the client
should also feel free to express any movements that emerge based on their
reaction to the music, as long as they can be done safely.
2. The music therapist will play the ostinato and allow the client to move to the
music. While playing, the music therapist should observe how the client is
responding to the music based on their body language and emotional affect, and
may need to adjust their musicality appropriately. This could include the
dynamics, phrasing, or length of the piece.
27
3. This intervention may have a pre-determined ending depending on the amount of
time available, or the music therapist and client may allow the music to continue
as long as necessary.
4. Once the experience comes to an end, the music therapist and client may discuss
feelings and thoughts surrounding the music. If verbal communication is not
possible, the music therapist may also allow time for the client to express their
thoughts and feelings afterwards through drawing.
5. One possible adaptation for this intervention if the client does not have wide
range of motion is for the music therapist to put the viola on the client’s lap while
plucking the ostinato and moving to the rhythm of the music, in order for the
client to feel the vibration of the instrument.
Indications and contraindications.
Indications may include the need to allow the client to creatively and emotionally express
themselves through motor movement, as understood through the assessment process.
Another indication may be the need to develop trust within the therapeutic relationship,
or to incorporate the client’s cultural and personal preferences. Contraindications may
include concerns around the client’s safety in their ability to move freely within the
space. If verbal processing is not possible with the client, the music therapist may adjust
this intervention to communicate instead using visual, auditory, or tactile cues. Any
clinical observations during the intervention in early sessions may lead the therapist to
change aspects of the activity to encourage further engagement and deepening of progress
towards goals in later sessions.
28
Chapter 5. Discussion
Findings Summarized
After reviewing the relevant research conducted on using one’s primary instrument in
music therapy and on the viola itself, I was able to create an outline for interventions to
be used within a music therapy setting with the viola. These interventions were realized
with attention paid to the goals, population, setting, and amount of time the therapist-
client relationship may be addressing. Within the frameworks of improvisational,
receptive, conducting, and movement interventions, the viola’s role in furthering clinical
progress was highlighted.
What the researcher has learned.
Perhaps what was most enlightening throughout this research process was realizing the
full scope and extent of this topic, which required more restrictions in the creation of
these interventions than previously thought. While this realization may be quite humbling
in some ways, it also provides context and reverence for past research that has been done.
Limitations.
Scope of research.
As this research only executed the first two step of Fraser and Galinsky’s intervention
research model, there was no opportunity to test the efficacy of these interventions in
clinical work. However, the initial process of intervention design allowed me to further
the existing research beyond the scope of what had previously been covered.
Researcher’s stance.
As the researcher, I was only able to approach the interventions from my own viewpoint
and within the confines of a music-centered lens, which influences their creation and
potential clinical application. On the other hand, being positioned as a researcher who has
extensive experience using the viola in a variety of musical and clinical settings, this
allowed me to have in-depth knowledge into how these interventions could be used and
created.
Cultural implications.
This research was written from a Western Canadian perspective with an instrument that
has come from the Western European music practices, and therefore the interventions
may need to be adapted to be suitable in other cultural contexts. While I have attempted
29
to be self-reflective of my cultural bias throughout this research process, there was no
opportunity to consult those with differing cultural perspectives firsthand.
What the researcher would have done differently.
Knowing now the scope of this type of research, perhaps it would have been useful to
narrow the parameters even further to create a more focused look at how the interventions
could be used, such as by narrowing down to a specific population or setting.
Implications for Future Research.
Testing interventions.
With the interventions developed, there are now opportunities for other music therapists
to test them and report on their results, which could be done through their own research
or via my own follow-up to this thesis. There is also the possibility to spend more time
refining the initial steps, or to apply them to particular populations, settings, and goals.
Gathering multiple viewpoints.
If possible, it would be beneficial and educational to dialogue with other violists in the
field to explore their experiences of using their instruments and incorporate this
information into the interventions. This would be particularly useful for those with very
different viewpoints from my own, such as researchers of other ages, genders, cultural
backgrounds, and years of experience.
Implementation on other instruments.
These interventions could potentially be adapted to be used on instruments other than the
viola, in order to take advantage of different aesthetic qualities or to serve the client in
different ways. The clearest link from this research in that regard would be to study other
string or orchestral instruments, but this could also be expanded to instruments outside of
the Western Classical framework.
Implications for clinical practice.
As research on interventions using one’s primary instrument increases and becomes more
refined, music therapy education may also be affected, either at a basic or more advanced
level. This diversification of music therapy practice could greatly affect how the field is
viewed by other professionals and by the general public. Hopefully, greater attention paid
30
to how instruments and musicality are used will serve to better benefit clients and allow
the music therapy profession to grow for the better.
31
References
Aasgaard, T., Murray, G., & Mottram, H. (2015). Lower brass (the trombone and the
euphonium). In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute,
accordion or clarinet?: Using the characteristics of our instruments in music
therapy (pp. 223-246). London: Jessica Kingsley.
Adout, M. L. (2016). Integrating the iPad into music therapy interventions for older
adults in long-term care. (Master’s thesis, Concordia University, Montreal, QC).
Retrieved from
http://spectrum.library.concordia.ca/981080/1/Adout_MA_S2016.pdf
Aigen, K. (2005). Music-centered music therapy. Gilsum, NH: Barcelona.
Aigen, K. (2008). In defense of beauty: A role for the aesthetic in music therapy theory.
Nordic Journal of Music Therapy, 17(1), 3-18. http://0-
dx.doi.org.mercury.concordia.ca/10.1080/08098130709478181
Aigen, K. (2014). Music-centered dimensions of Nordoff-Robbins music therapy. Music
Therapy Perspectives, 32(1), 18-29. doi: 10.1093/mtp/miu006
Allen, D. (2015). Trombone. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 87-91). Dallas, TX: Barcelona.
Anderson, C., Austin, V., Corke, E., Fearn, M-C., Mitchell, E., & Tomlinson, J. (2015).
The flute. In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute,
accordion or clarinet?: Using the characteristics of our instruments in music
therapy (pp. 69-94). London: Jessica Kingsley.
Annesley, L., Crociani, S., Davidson, B., & Vaz, A. (2015). The saxophone. In D.
Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?:
Using the characteristics of our instruments in music therapy (pp. 265-286).
London: Jessica Kingsley.
Bachmann, W. et al. (2017). Bow. Grove Music Online. Retrieved from http://0-
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/03753
Baker, F., & Uhlig, S. (2011). Voicework in music therapy: Research and practice.
London: Jessica Kingsley.
32
Barbieri, J. M. (2015). Addressing perceived pain in childbirth: A music therapy
voicework intervention design. (Master’s thesis, Concordia University, Montreal,
QC). Retrieved from
http://spectrum.library.concordia.ca/979869/1/Barbieri_MA_S2015.pdf
Bell, J. (2016). Music therapy and percussion for persons with dementia: A systematic
literature review. (Master’s thesis, Concordia University, Montreal, QC).
Retrieved from
https://spectrum.library.concordia.ca/981092/1/Bell_MA_S2016.pdf
Bell, K., Haire, N., Montague, T., & Warnes, S. (2015). The violin. In D. Loombe, S.
Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?: Using the
characteristics of our instruments in music therapy (pp. 147-164). London:
Jessica Kingsley.
Berends, A. (2014). What do orchestral instruments bring to music therapy? Developing
my voice on the oboe and English horn as a music therapist. Canadian Journal of
Music Therapy, 20(2), 13-31.
Berends, A. (2015). Oboe. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 78-81). Dallas, TX: Barcelona.
Bettany, N., Dickinson, S. C., & Knoll, S. L. (2015). The oboe. In D. Loombe, S.
Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?: Using the
characteristics of our instruments in music therapy (pp. 247-264). London:
Jessica Kingsley.
Birnstingl, P., Margetts, L., Burley, J., & Watts, G. (2015). The bassoon. In D. Loombe,
S. Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?: Using the
characteristics of our instruments in music therapy (pp. 135-146). London:
Jessica Kingsley.
Boyden, D. D., & Woodward, A. M. (2017). Viola. Grove Music Online. Retrieved from
http://0-
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/29438
Brittain, B. (2013). The use of the viola in music therapy. (Unpublished Major Research
Paper). Wilfrid Laurier University, Waterloo, ON.
33
Brittain, B. (2015). Viola. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 102-105). Dallas, TX:
Barcelona.
Canadian Association of Music Therapists (2018). Retrieved from
https://www.musictherapy.ca/about-camt-music-therapy/about-music-therapy/
Chapman, E. (2006). Take care and beware: A guide for viola maintenance! Journal of
the American Viola Society, 22, 1-5. Retrieved from
http://www.americanviolasociety.org/Journal/Archives-Free.php
Chew, G. (2017). Legato. Grove Music Online. Retrieved from http://0-
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/16290
Chew, G., & Brown, C. (2017). Staccato. Grove Music Online. Retrieved from http://0-
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/26498
Derrington, P., Gilroy, M., Hason, S., & Tomaino, C. (2015). The trumpet and the
flugelhorn. In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute,
accordion or clarinet?: Using the characteristics of our instruments in music
therapy (pp. 111-134). London: Jessica Kingsley.
Dunn, H., Oldfield, A., Piears-Banton, C., & Salkeld, C. (2015). The clarinet. In D.
Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?:
Using the characteristics of our instruments in music therapy (pp. 21-40).
London: Jessica Kingsley.
Fraser, M. W., & Galinsky, M. J. (2010). Steps in intervention design research:
Designing and developing social programs. Research on Social Work Practice,
20(5), 459-466. doi: 10.1177/1049731509358424
Fuller-Maitland, J. A., & Fallows, D. (2017). Marcato. Grove Music Online. Retrieved
from http://0-
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/17712
Gilboa, A., Zilberberg, D., & Lavi, D. (2011). What’s a piano? Music therapists portray
34
the “musical personality” of the piano. Music Therapy Perspectives, 29(2), 138-
148. doi: 10.1093/mtp/29.2.138
Goldscheid, A. (2016). Using music therapy to help Jewish children with different
abilities complete their bar/bat mitzvah. (Master’s thesis, Concordia University,
Montreal, QC). Retrieved from
http://spectrum.library.concordia.ca/981077/1/Goldscheid_MA_S2016.docx.pdf
Gottlieb, R., Lockett., A., & Mentzer, H. (2015). The harp. In D. Loombe, S. Rodgers, J.
Tomlinson, & A. Oldfield, Flute, accordion or clarinet?: Using the
characteristics of our instruments in music therapy (pp. 177-198). London:
Jessica Kingsley.
Greenhalgh, S., Loombe, D., Powell, H., Santilly, B., & Ward-Bergeman, M. (2015). The
piano accordion. In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute,
accordion or clarinet?: Using the characteristics of our instruments in music
therapy (pp. 41-68). London: Jessica Kingsley.
Harrison, A., & Jones, O. (2015). The viola. In D. Loombe, S. Rodgers, J. Tomlinson, &
A. Oldfield, Flute, accordion or clarinet?: Using the characteristics of our
instruments in music therapy (pp. 165-176). London: Jessica Kingsley.
Hughes, P., Tyhurst, A., Warner, C., & Watson, T. (2015). The cello. In D. Loombe, S.
Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?: Using the
characteristics of our instruments in music therapy (pp. 95-110). London: Jessica
Kingsley.
Jones, O. (2004) “I didn’t know you could do music therapy on a viola!” Exploring the
music therapist’s choice of instrument and the influence it has on the music
created. (Unpublished master’s dissertation). Nordoff-Robbins library, London,
UK.
Kroeker, S. (2015). Cello. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 106-109). Dallas, TX:
Barcelona.
Krout, R. E. (2007). The attraction of the guitar as an instrument of motivation,
preference, and choice for use with clients in music therapy: A review of the
literature. The Arts in Psychotherapy, 343, 6-52. doi:10.1016/j.aip.2006.08.005
35
Lee, C. A., Berends, A., & Pun, S. (2015). Composition and improvisation resources for
music therapists. Dallas, TX: Barcelona.
Lee, C., & Cheung, E. (2015). Clarinet. In C. A. Lee, A. Berends, & S. Pun, Composition
and improvisation resources for music therapists (pp. 82-86). Dallas, TX:
Barcelona.
Lepnik, E. (2015). Flute. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 74-77). Dallas, TX: Barcelona.
Loth, H. (2006). How Gamelan music has influenced me as a music therapist: A personal
account. Voices: A World Forum for Music Therapy, 6(1).
doi:10.15845/voices.v6i1.246
Loombe, D., Rodgers, S., Tomlinson, J., & Oldfield, A. (2015). Flute, accordion or
clarinet?: Using the characteristics of our instruments in music therapy. London:
Jessica Kingsley.
Lyons, S., Poole, J., Long, C., Street, A., & Stylianou, P. (2015). The guitar. In D.
Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion or clarinet?:
Using the characteristics of our instruments in music therapy (pp. 199-224).
London: Jessica Kingsley.
Matney, B. (2017). Review article: The effect of specific music instrumentation on
anxiety reduction in university music students: A feasibility study. The Arts in
Psychotherapy, 5447-55. doi:10.1016/j.aip.2017.02.006
Matsumura-McKee, N. (2010a). Exploring listeners' responses to violin techniques for
music therapy (Master’s thesis). Wilfrid Laurier University, Waterloo, ON,
Canada. Retrieved from
http://www.wlu.ca/soundeffects/researchlibrary/Matsumura-McKeeNaoko.pdf
Matsumura-McKee, N. (2010b). Finding power and privilege as a violinist and music
therapist. Voices: A World Forum for Music Therapy, 10(2).
doi:10.15845/voices.v10i2.162
Matsumura-McKee, N. (2015). Violin. In C. A. Lee, A. Berends, & S. Pun, Composition
and improvisation resources for music therapists (pp. 98-101). Dallas, TX:
Barcelona.
Monosoff, S. (2017). Pizzicato. Grove Music Online. Retrieved from http://0-
36
www.oxfordmusiconline.com.mercury.concordia.ca/subscriber/article/grove/musi
c/21883
Neuman, W. L. (2006). Social research methods: Qualitative and quantitative
approaches. Pearson.
Odell-Miller, H. (2011). Memories of Tony Wigram: His early career. Voices: A World
Forum for Music Therapy, 11(3). doi:10.15845/voices.v11i3.599
Oldfield, A. (2011). Music that speaks volumes to children. Learning Disability Practice,
14(3), 9.
Oldfield, A. (2015). Introduction. In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield
Flute, accordion or clarinet?: Using the characteristics of our instruments in
music therapy (pp. 13-20). London: Jessica Kingsley.
Piccinninni, J., Pizziolo, P., & Preston, J. (2015). The bass (the double bass and the bass
guitar). In D. Loombe, S. Rodgers, J. Tomlinson, & A. Oldfield, Flute, accordion
or clarinet?: Using the characteristics of our instruments in music therapy (pp.
287-308). London: Jessica Kingsley.
Schenstead, A. (2009). Performing musical liberation: The flute and the self in
improvisation exploration and music therapy practice (Master’s thesis). Wilfrid
Laurier University, Waterloo, ON, Canada. Retrieved from
http://www.wlu.ca/soundeffects/researchlibrary/Amanda_MRP_2010.pdf
Shoemark, H. (2009). Sweet melodies: Combining the talents and knowledge of music
therapy and elite musicianship. Voices: A World Forum for Music Therapy,
9(2). doi:10.15845/voices.v9i2.347
Soshensky, R. (2005). Developing a guitar-based approach in Nordoff-Robbins music
therapy. Music Therapy Perspectives, 23(2), 111-117. doi: 10.1093/mtp/23.2.111
Stige, B. (2000). The voice and warmth of a cello. Nordic Journal of Music Therapy,
9(1), 46-49. http://0-
dx.doi.org.mercury.concordia.ca/10.1080/08098130009477985
Stowell, R. (2001). The early violin and viola: A practical guide. New York: Cambridge
University Press.
Strange, A., & Strange, P. (2001). The contemporary violin:
Extended performance techniques. Berkeley: University of California Press.
37
Sumrongthong, B., & Aksaranukraw, S. (2004). The use of Thai musical instruments as
a tool in music therapy with Akaboshi's musical therapy method. Voices: A World
Forum for Music Therapy, 4(1). doi:10.15845/voices.v4i1.147
Sun, K. (2012). The use of the orchestral marimba in music therapy (Unpublished
master’s thesis). Wilfrid Laurier University, Waterloo, ON, Canada.
Sun, K. (2015). Marimba and xylophone. In C. A. Lee, A. Berends, & S. Pun,
Composition and improvisation resources for music therapists (pp. 92-97).
Dallas, TX: Barcelona.
Uhlig, S. (2009). Voice forum: The voice as primary instrument in music therapy. Report
from a symposium at the XII World Congress of Music Therapy, Buenos
Aires, Argentina, 22-26 July 2008. Voices: A World Forum for Music Therapy,
9(1). doi:10.15845/voices.v9i1.365
Vaux, D. (2010). Helen Bonny as a musician. Voices: A World Forum for Music
Therapy, 10(3). doi:10.15845/voices.v10i3.339
Voyajolu, A. (2009). The use of the music therapist's principal instrument in clinical
practice (Unpublished master’s thesis). Montclair State University, New Jersey.
Wan, M. (2015). Double bass. In C. A. Lee, A. Berends, & S. Pun, Composition and
improvisation resources for music therapists (pp. 110-113). Dallas, TX:
Barcelona.
Wiess, C., Dassa, A., & Gilboa, A. (2017). The clinical and theoretical trends of music
therapists: The Israeli case. Voices: A World Forum for Music Therapy, 17(1).
doi:10.15845/voices.v17i1.889
Yeo, D. K. L., Pham, T. P., Baker, J., & Porter, S. A. T. (2002). Specific orofacial
problems experienced by musicians. Australian Dental Journal, 47(1), 2-11.
doi:10.1111/j.1834-7819.2002.tb00296.x